Provider Demographics
NPI:1699089383
Name:BARBOSA, ERNESTO (DMD)
Entity type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:
Last Name:BARBOSA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 CHEPSTOW AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-1246
Mailing Address - Country:US
Mailing Address - Phone:702-278-0876
Mailing Address - Fax:
Practice Address - Street 1:1703 CIVIC CENTER DR STE 6
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7273
Practice Address - Country:US
Practice Address - Phone:702-649-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6060122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist